Exploration of Occupational Deprivation Among Syrian Refugees Displaced in Jordan

Study Design

Grounded theory was the methodology used for this research study. This approach can generate a theory from data that have been systematically and iteratively gathered and analyzed to gain a more in-depth understanding of concepts or processes (Glaser, 2005). Grounded theory uses a constant comparative method of analysis until a point of saturation is reached at which further analysis no longer contributes to theory development (Breckenridge, 2012; Clarke & Friese, 2007).

Participants and Recruitment

Potential participants were required to be adults (≥18 yr) and to provide written consent. The participants also consented to tape-recorded interviews before the start of the study. Four sampling methods were used in this study: convenience sampling, purposive sampling, snowball sampling, and theoretical sampling (Morse, 2007). Purposive sampling was implemented when participants living outside camps in the Amman and Jerash provinces were selected. Amman is the capital of Jordan, so the infrastructure, services, and job opportunities were expected to attract more participants. Jerash, however, is close to the Jordanian–Syrian border, so a large number of potential participants was also expected.

Potential participants living outside the Zaatari camp were approached in malls, libraries, and cafes. Snowball sampling was used to locate other potential participants, such as workers, housewives, and people without employment. Participants from inside the Zaatari camp were approached by a research assistant who lived and worked in the camp; thus, he was well acquainted with the refugees, which encouraged them to participate. Theoretical sampling was implemented to aid in theory development and supplementation when interviewing participants from inside refugee camps who had experienced displacement for at least 1 yr. The need to implement convenience sampling arose when the Zaatari camp was selected because of accessibility issues in approaching participants.

Forty-nine participants were recruited; 24 lived outside the refugee camps, and 25 lived in the Zaatari camp. There were 19 women and 30 men (mean age = 34.6 yr, standard deviation [SD] = 9.9, range = 20–60). Of the participants, 18.4% had completed their primary school education, 18.4% had completed their middle school education, 30.6% had completed high school, and 32.7% had obtained an undergraduate degree. The length of time that participants had been refugees ranged between 12 and 48 mo (mean = 25 mo, SD = 7). Data gathering took place from the end of 2014 to the beginning of 2016.

Data Collection and Analysis

Semistructured interviews were used for in-depth data collection and to maintain flexibility when exploring potential concepts. Each recorded interview lasted 60–90 min. The interviews included the following sample open-ended questions: “How have you spent your days since arriving in Jordan?” “How do you describe the level of your function/performance in meaningful occupations now?” “How do you spend your time in the current camp/context?” “How do you feel about that?” If the person moved from inside to outside the refugee camp, the following questions were asked: “How can you compare the level of your function inside and outside the refugee camp?” “How does that compare with your level of function in your home country?” Questions in the topic guide served as pointers and were typically followed by prompts, such as “Can you elaborate on that?” or “Give an example from your experience.”

Audio records of the interviews were transcribed verbatim before coding, and then the interview narratives were used as data for analysis. The data were gathered and analyzed in the Arabic language, and no translators were involved because Arabic was the primary language of both the research team and the participants. The data analysis was carried out by constructing a coding system originating from open, axial, and selective coding (Glaser, 2005). Throughout this process, free codes that first emerged were linked in constant comparison with one another to generate axial codes (Breckenridge, 2012). Finally, all data were considered for analysis, and core codes were identified through selective coding (Clarke & Friese, 2007).

The research team consisted of three research assistants and the author, who are all knowledgeable about qualitative research methodologies. The research team reviewed the process of analysis and checked for consistency in reaching findings as a measure of peer debriefing to increase credibility (Darawsheh, 2014; Houghton et al., 2013).

Deprivation From Sense of Meaning and Sense of Humanity: “I Feel Unworthy”

When participants were asked, “How can you compare the level of your function before and after displacement?” they expressed several responses that fit into five categories of occupations identified by the American Occupational Therapy Association (2014): instrumental activities of daily living (driving and community mobility), social participation (community, family, peer, friend), leisure, work (job performance and volunteer participation), and education.

Participant 8 (P8; 3 yr [3 yr since being displaced], out [outside Zaatari camp]) expressed a restriction in social activities:

Work occupations were affected in several ways. Some participants stopped working; others changed their jobs: “I used to work as a nurse in Syria, but currently, being a refugee, I had to stop. Things have changed 100%” (P1, 2 yr, in [inside Zaatari camp]). Other refugees who had not previously had a job started to work in Jordan. An example is Participant 4 (2 yr, out):

Participants living inside and outside camps reported being deprived of occupations that provided a sense of self-development: “I got used to my current job! I’m getting familiar with prices, classifying stuff there, just a saleswoman, nothing more. There is no foreseeable progress in my life!” (P3, 2 yr, out). Some participants expressed a strong feeling of inferiority and even living like “animals” with no aspirations or life prospects: “I will say it bluntly. Animals sleep and graze. That’s it. We [Syrian refugees] are similar to animals [banging the table with his hand]” (P1, 1 yr, out).

Because participants could no longer perform meaningful occupations, they dedicated their time and focus to other duties, particularly child-rearing (“Currently, I am devoted to my children. I have three. I also think about Syria and pray for it, nothing else” [P24, 2 yr, out]) and religious and spiritual activities (“At sunset, the only activity that we do is reading religious books” [P11, 2.5 yr, in]). Participants also searched for meaning in the new occupations they learned to perform, such as gardening (“At dawn, we pray, and then sit outside. I water roses, which I planted outside, every day” [P16, 2.5 yr, in]) and origami (“I have learnt the art of origami from YouTube. I then tried to sell my products to a store” [P10, 1 yr, out]). The specific desire to practice occupations related to, for example, gardening or craft work, is associated with Syrian society and culture. If refugees had been of another nationality, they might have chosen other forms of occupations.

Perception of Time: “Actually, There Is No Sense of Time at All”

Those who lived inside the Zaatari camp and those who lived elsewhere perceived time differently. Participants inside the camp reported having too much time. This lack of activity resulted in several disadvantages in regard to health and well-being: “One of the main consequences is that the youngsters are socially suppressed because they are not given the opportunity to work outside the camp. Therefore, they end up having a lot of free time that leads them to misdemeanors” (P4, 1.5 yr, in). Those who lived outside the refugee camps reported a lack of free time because of their long working hours: “Actually, there is no sense of time because we work 12 actual hours, 24/7” (P3, 2 yr, out).

Isolation and Segregation: “I Feel Like a Total Stranger”

Those inside the Zaatari camp and those outside the camps experienced social isolation differently. The refugee camp formed a community consisting of members who shared the same experiences and country of origin. As such, the refugees inside the camp developed support networks that facilitated the process of adaptation to the experience of displacement:

Participants who lived outside the camp reported feeling isolated and segregated: “In Syria, I felt settled, I owned a house. If I wanted to visit someone, I used to go for it. If not, I just didn’t. Now things are different. I feel like a total stranger” (P16, 2 yr, out). In addition, they experienced sociocultural differences and difficulties in integration: “Life is now different; here, it is a big issue to consider visiting an acquaintance even for an hour, whereas in Syria, you just go for it” (P6, 2.5 yr, out).

Social Injustice: “There Are No Job Opportunities for Us”

Participants located both outside and inside the camp reported a sense of social injustice that intensified their marginalization. The feeling of injustice mainly arose from being underappreciated and being denied the right to work without consideration of their level of education and experience: “There are no job opportunities for us [Syrians]. With the restrictions imposed by legislation on us, we feel trapped” (P24, 2 yr, out). This situation was also evident in the presence of discriminatory working conditions in payment and work hours:

Occupational Deprivation and Self-Development: Sense of Humanity and Value

Refugees struggle to live their own lives meaningfully while preserving their autonomy, identity, and dignity (Alcock, 2011). Participants in this study experienced OD that affected their sense of self-efficacy, control, and self-respect (Whiteford, 2000). OD was found to be more evident in certain occupations than others, such as work and social activities. Participants identified specific occupations to compensate for the sense of deprivation, such as origami, gardening, and making accessories and ornaments. The main motivation for participating in those occupations was to get a sense of meaning, human worth, and self-actualization (Alcock, 2011). The reason behind the specific experience of OD in some occupations and the shift to other occupations, in particular, has to do with the way the Syrian refugees conceptualized the sociocultural meaning of the experience of OD and displacement. This outcome supported the findings of another study by Huot et al. (2016), who stressed the need to understand the cultural meaning of occupations if refugees’ coping with the displacement experience is to be accomplished.

Sense of Time and Occupational Imbalance

OD compromises the sense of time (Morville et al., 2015), and this outcome was one of the main themes in the current investigation. Whiteford (2000) found that prisoners, for example, who experienced OD had apathy toward time, which resulted in difficulty identifying their place in time. This finding resonated with the results of this study. The sense of time of refugees inside the Zaatari camp and those outside the camps was compromised in different ways.

Participants reported a sense of occupational imbalance, which is a sense of dissatisfaction with the variety and number of occupations (Wagman et al., 2012).This finding coincides with the results of several studies in which refugees experienced a change in their daily routine and occupations that compromised leisure and work (Morville et al., 2015). Studies have shown that low satisfaction can be an indicator of occupational imbalance (e.g., Morville et al., 2015). Participants in this study reported low self-esteem, a feeling of dehumanization, frustration, deterioration of health, and a lack of well-being. Several studies have also indicated that the experience of displacement causes occupational disruption, which compromises occupational balance (Morville & Erlandsson, 2013; Steindl et al., 2008). With time, occupational disruption turns into a state of OD, eventually causing occupational dysfunction (Morville & Erlandsson, 2013).

Occupational Deprivation: Social and Occupational Injustice

OD is an indicator of occupational injustice and is a hurdle toward achieving social inclusion (Correa-Velez et al., 2012; Townsend & Wilcock, 2004). In this study, participants stated that there were barriers to their engaging in work and social occupations, and they also reported a feeling of unfairness. The risk of refugees being subjected to marginalization and social exclusion was noted by Mirza (2012) and resonates with the literature showing the influence of legal restrictions and sociocultural barriers on social justice (Boyle, 2014; Correa-Velez et al., 2012).

The role of occupational therapy practitioners in relation to occupational injustice needs to be further delineated with refugees (Townsend & Wilcock, 2004; Whiteford, 2000). In addition, there is a need to support refugees in the provision of resources and opportunities to engage in meaningful occupations. This task requires developing occupational programs based on a careful understanding of the occupational needs of refugees and what they consider meaningful to assist them in coping with the displacement experience (Huot et al., 2016; Morville et al., 2015).

Occupational Deprivation and the Pursuit of Meaningful Occupations

Huot et al. (2016) and Morville et al. (2015) recommended that refugees be offered a repertoire of occupations that are meaningful to them and that meet their level of satisfaction—a recommendation that is supported by the current study. However, limited available resources hinder the fulfillment of this recommendation, especially in countries with limited resources, such as Jordan. Organizations directed to serve the welfare of refugees in the Zaatari camp have organized multiple activities and workshops. Such activities appeared to be random and did not match the interests of the refugees; hence, they were not meaningful to them. Participants reported disappointment and dissatisfaction with their engagement in such activities, and they rationalized such engagement as a way to aimlessly pass time (Morville et al., 2015).

The findings of this study agree with the literature showing that when occupations are performed to pass time, people’s sense of identity, health, well-being, and level of satisfaction decrease (Bennett et al., 2012). This outcome has occurred because the activities that have been offered have not been based on research into the sociocultural meaning embedded in occupations. Organizations have not yet taken into account the value of occupations to refugees (Morville & Erlandsson, 2013; Steindl et al., 2008). The number of activities is not beneficial to counteracting OD; in fact, the number of performed occupations has not been associated with level of satisfaction (Bennett et al., 2012). To facilitate a sense of normalization and adaptation, occupations organized in refugee camps need to have meaning to the refugees and need to stimulate the occupations they performed before the trauma. (Danish Immigration Service, 2013; Morville & Erlandsson, 2013).